School-Based Asthma Therapy (SBAT) to Reduce Disparities in Childhood Asthma: Pragmatic Process and Program

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PROJECT ABSTRACT Over 25% of the nation’s school-aged children have one or more chronic health conditions and school nurses are responsible for coordinating care management with youth and their caregivers. Coordinated efforts improve health, reduce school absences, and mitigate the billions of dollars spent on youth disease management. However, pragmatic (“real world”) interventions to improve connection between nurses, youth, and their caregivers are nascent. One approach was developed by Dr. Halterman (co-I) and colleagues to ensure guideline-based treatment for children with persistent asthma through systematic school-based asthma screening and directly observed administration of asthma controller medications in school. This intervention was titled the School-Based Asthma Therapy (SBAT). Through numerous randomized controlled trials, SBAT was found to enhance asthma self-management and improve adherence to daily, effective preventive asthma care (clinical effect) as well as reduction in symptom-free days (cost-effective). SBAT is multidimensional, extending child asthma care from the home to the school setting. SBAT is high-impact because school-based programs can reach children at highest risk for asthma morbidity and optimize their care in the setting in which they spend most of their day, regardless of their contacts with the health care system. In alignment with the RE-AIM framework, the goal of this work is to improve the reach of students and effectiveness of asthma management outcomes, be broadly adopted among schools and school districts, be implemented with high quality and at a low cost, and be maintained within the schools and homes of asthmatic youth. Over the last five years, our team based at the Nationwide Children’s Hospital (NCH), its physician-hospital organization, Partners for Kids (PFK), and the University of Rochester has expanded the SBAT program beyond the original Columbus City and South Western City School Districts (Columbus, OH) and found strong adoption (17 to 225 schools) and reach (38 students to 559 students) outcomes with the application of SBAT. Despite the promises of SBAT, widespread dissemination of the program has not been fully achieved because a comprehensive assessment of real-world implementation and evaluation of this program has not been done. Our team is now poised to move from efficacy studies to a hybrid effectiveness-implementation study. We will conduct a rigorous, comprehensive evaluation of SBAT implementation outcomes (i.e., clinical and academic outcomes, and cost-effectiveness) when implemented in a real-world setting. We will also assess the implementation strategies in facilitating further dissemination and implementation of the SBAT program across a variety of schools. Dissemination and implementation research on this integrated, interprofessional, multidimensional SBAT program could serve as a model for programs that aim to improve asthma care and reduce morbidity for high risk children with asthma and has applications for other chronic health conditions.